Let’s talk about sex…. and the role of the pelvic floor in sexual health

By: Dr. Katie Ihlenfeldt, PT, DPT

As pelvic floor physical therapists we know how crucial pelvic health is for pain free, pleasurable intercourse for both men and women.  However, many people are unaware of how the pelvic floor muscles are involved in intimacy, so below I’ve outlined what our pelvic floor muscles do during intercourse and how a pelvic floor physical therapist can help if you are experiencing issues.

To have pain free and pleasurable intercourse for both men and women, the pelvic floor muscles need to be able to completely relax and contract.  If the muscles are contracted and unable to relax this can cause sex to be painful for both men and women. If the muscles are unable to contract efficiently this can lead to decreased sensation and inability to orgasm.  For women, pelvic floor muscles need to be able to relax and lengthen if penetration is part of intimacy.  For men, the pelvic floor muscles are responsible for achieving and maintaining an erection. Orgasms for both men and women are involuntary contraction and relaxation of the pelvic floor muscles, so again if orgasms have decreased in intensity, are painful, or are not able to be achieved the pelvic floor muscles could be at fault. 

For women, increased tension in the pelvic floor can cause symptoms like:

• Burning or a sharp pain with penetration

• Feeling like there is a “wall” that prevents full penetration 

• Pain with orgasm or inability to have orgasms

• After child birth if there is tearing, scar tissue from stitches can also cause some discomfort during intercourse

• Breastfeeding can also lower estrogen levels that can decrease lubrication and blood flow to the tissues which can also lead to pain and discomfort during intercourse.

For women, decreased tension or decreased strength within the pelvic floor muscles can cause:

• Decreased sensation 

• Decreased intensity or inability to experience an orgasm

For men, increased tension in the pelvic floor can cause:

• Pain with erection

• Erectile dysfunction

• Prejaculation

For men, decreased tension in the pelvic floor can cause:

• Erectile dysfunction 

• Decreased strength or difficulty with ejaculation 

So, what can pelvic floor physical therapy do to help?

We first assess the pelvic floor muscle tone, strength, coordination, and endurance. With a pelvic floor exam we are also looking for what muscles are causing pain if that is a symptom someone is experiencing. Being evaluated by a HOPE Doctor also means that we will be looking at the entire body because issues with the pelvic floor also means there is something else going on up or down the change of the body that is contributing.  We take all this into account, along with other personal history to develop a personalized treatment plan that could include stretches, exercises, and changes in lifestyle habits.  Treatment could also include the use of dilators and a pelvic wand if indicated.  

It’s also important to recognize that sexual health and experience is not just physical but intimately tied to emotional and psychological health both as an individual and between partners.  This is why we have a list of amazing providers we trust if we feel an outside referral is needed.  

If you are experiencing any form of sexual dysfunction, we can help as pelvic floor physical therapists! Please reach out with any specific questions or book an appointment to get started!